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Lower Your Risk of Heart Disease Without Drugs

Posted Sep 17 2008 12:04am 1 Comment

Last week, I explained how preventing heart disease has very little to do with lowering cholesterol with statin drugs.

Today, I am going to tell you how to lower your heart disease risk as well as your cholesterol using a comprehensive dietary and lifestyle approach.

==> Dietary Recommendations to Help Prevent Cardiovascular Disease

The first step in preventing heart disease is to eat a healthy diet. Increase your consumption of whole foods rich in phytonutrients, plant molecules that give your body the nutrients it needs.

Here are some practical tips:

  1. To avoid the blood sugar imbalances that increase your risk for heart disease, eat protein with every meal, even at breakfast. This will help you to avoid sudden increases in your blood sugar.
  2. Use lean animal protein like fish, turkey, chicken, lean cuts of lamb, and even vegetable protein such as nuts, beans and tofu.
  3. Combine protein, fat, and carbohydrates in every meal. Never eat carbohydrates alone.
  4. For the same reasons, avoid white flour and sugar
  5. Eat high fiber foods, ideally at least 50 grams per day. Beans, whole grains, vegetables, nuts, seeds, and fruit all contain beneficial fiber.
  6. Avoid all processed junk food, including sodas, juices, and diet drinks, which impact sugar and lipid metabolism.
  7. Increase omega-3 fatty acids by eating cold-water wild salmon, sardines, herring, flaxseeds, and even seaweed.
  8. Reduce saturated fat and use more grass-fed or organic beef or animal products, which contain less saturated fat.
  9. Eliminate all hydrogenated fat, which is found in margarine, shortening, and processed oils, as well as many baked goods and processed foods.
  10. Instead use healthy oils, such as olive (especially extra virgin olive oil), cold pressed sesame, and other nut oils.
  11. Avoid or reduce alcohol, which can increase triglycerides and fat in the liver and create blood sugar imbalances.
  12. Don’t allow yourself to get hungry. Graze -- don’t gorge -- by eating every three to four hours to keep your insulin and blood sugar normal.
  13. Try not to eat three hours before bed.
  14. Have a good protein breakfast every day. You can start with a protein shake or may use eggs. Some suppliers offer omega-3 eggs, which are ideal.
  15. Include flaxseeds by using two to four tablespoons of ground flaxseeds every day in your food. This can lower cholesterol by 18 percent. Flax is tasty in shakes or sprinkled on salads or whole grain cereal.
  16. Drink green tea, which can help lower cholesterol.
  17. Use soy foods such as soymilk, edamame, soy nuts, tempeh, and tofu, which can help lower cholesterol by 10 percent.
  18. Eat at least eight to ten servings of colorful fruits and vegetables a day, which contain disease fighting vitamins, minerals, fiber, phytonutrients, antioxidants, and anti-inflammatory molecules.

==> Supplements

Supplements are important. Along with a healthy diet and exercise program, they can dramatically affect your risk of cardiovascular disease. Combining these together can have the greatest impact on your cholesterol.

Here are the supplements I have found most useful in my practice to lower cholesterol and even prevent and reverse heart disease:

  1. Everyone must take a good multivitamin and mineral, as well as a purified fish oil supplement that contains 1000 to 2000 grams a day of EPA/DHA. More may be necessary for those with low HDL and high triglycerides
  2. Try policosanol (10 mg to 20 mg twice a day), which is from sugarcane wax and can help lower cholesterol.
  3. Red rice yeast (two 600-mg capsules twice a day), which is another powerful cholesterol-lowering herbal formula.
  4. Plant sterols (beta-sitosterol and others) can help lower cholesterol. Take 2 grams a day.
  5. A soy protein isolate shake can be helpful in lowering cholesterol by about 10 percent.
  6. Fiber supplements such as WellbetX PGX (Konjac fiber) -- 4 before each meal with a glass of water -- can both lower cholesterol and balance blood sugar metabolism.

There are other suggestions and therapies, but these will work for most people. Working with a doctor specializing in nutritional therapy can help sort out questions or difficulties that arise.

==> Lifestyle and Exercise

I encourage 30 to 45 minutes of cardiovascular exercise at least six times a week.

You may try interval training (also known as wind sprints and described in “UltraMetabolism”) if you are feeling stronger. I also encourage strength training to build muscle and reduce body fat composition.

Exercise is a necessity, not a luxury, in preventing almost all chronic disease, from heart disease to cancer, from dementia to diabetes, from osteoporosis to osteoarthritis. You cannot age successfully with out it. It is how we are designed.

==> Stress Reduction
Stress alone can cause a heart attack. It is often the trigger that leads to the cascade of events that causes that final, fatal heart attack.

But all along the way, it contributes to heart disease by creating inflammation, raising your cholesterol and blood sugar, causing high blood pressure and even making your blood more likely to clot.

Therefore, finding ways to manage stress, to relax, and to find the pause button is essential for dealing with nearly all chronic health conditions, including high cholesterol.

Learn to reduce stress by doing regular relaxation exercises such as yoga, tai chi, meditation, breathing, guided imagery, or whatever it takes to engage the relaxation nervous system, which can lower cholesterol and reduce your overall level of inflammation and blood sugar and increase metabolism and help with your overall health.

Try classes, buy tapes, try therapy, or just go out and have fun. But you must do something to switch daily out of the alarm response to maintain your health.

==> Medications

Occasionally I will recommend medications if I feel that my patient is swimming upstream genetically, or if there is significant heart disease present already. Then I can carefully weigh the risks and the benefits of medications.

However, it is possible to achieve most of the benefits of medications through lifestyle. Dr. David Jenkins from the University of Toronto compared treatment with statin drugs (the number-one cholesterol medication) to a diet high in viscous fiber, almonds, soy, and plant sterols and found they were equal, although the diet was more effective in lowering inflammation and homocysteine.

In fact, many of my patients have lowered their cholesterol over 100 points by following the comprehensive program I outline above.

In the rare occasions when I do need to use medications, here are the ones I have to choose from:

1) Statins

These work by blocking the production of cholesterol in the liver. They can also lower inflammation and very high doses may even reverse plaque or fatty deposits in the arteries.

Though now widely prescribed, statin medications do have significant side effects, in that they deplete the body’s stores of the vital component Coenzyme Q10. If you’re on statins, it’s a good idea to supplement with at least 100 mg of CoQ10 a day.

Many patients have to stop taking statins because of muscle pain and aching, known as statin myopathy. It is more common that most people think.

And you must have your liver function checked regularly and have your muscle enzymes (CPK) measured to make sure you can continue the medications safely.

2) Niacin

Niacin is also known as vitamin B3, and in very high doses (1000 to 3000 mg a day) can be very helpful for raising good cholesterol (HDL) and lowering high triglycerides -- something that statins are not very effective at.

I use niacin often in my patients who have insulin resistance or pre-diabetes. The major side effect is flushing (sort of like hot flashes), which are benign, subside after an hour, and reduce completely over a few weeks. You can stop flushing by taking a baby aspirin (81mg) half an hour before your take the niacin.

I usually recommend long-acting Niaspan and build up slowly over the course of 2 to 6 weeks to the desired dose of 1500 to 2000 mg daily.

3) Ezetimbe (Zetia)

Zetia prevents absorption of cholesterol from the intestine. It can interact with the statins to increase the risk of liver toxicity.

4) Fibrates

This class of medications includes drugs such as fenofibrate (Tricor) and gemfibrozil (Lopid) and helps to lower triglycerides and raise HDL. These drugs also act on a newly discovered class of receptors that control inflammation and blood sugar called PPAR, which I talk about in “UltraMetabolism.”

The verdict is still out on their effectiveness and safety. I prefer to use niacin, which achieves the same results, at lower cost with less risk.

5) Bile Acid Binding Agents

Drugs like Questran and WellChol bind up bile in the gut and promote the elimination of cholesterol from the body. Bile is comprised of cholesterol among other things, and getting rid of bile helps lower your cholesterol.

==> Summary

Remember, cholesterol is only one of many factors that lead to cardiovascular disease. Many other things need to be assessed.

Diet, supplements, exercise, and other lifestyle approaches can have a huge impact on your outcome and have dramatic effects on cholesterol, lowering it by 100 points or more within a few months of comprehensive therapy.

Medications are available as a last resort, but I never start them without trying an integrated approach to cholesterol management.

If you are willing to make the changes in diet and lifestyle and take a few supplements, your numbers may change dramatically -- and so will your life.

Now I’d like to hear from you…

Have you taken medications to lower cholesterol? Have you had any side effects?

Have you tried any of the lifestyle measures mentioned here?

What do you plan to do to lower your risk of heart disease?

Please click on the Add a Comment button below to share your thoughts.

To your good health,

Mark Hyman, M.D.

Comments (1)
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I am at my wit's end as to how to lower my cholesterol.  I eat a healthy diet--fruits, vegetables, whole grains, lean protein, soy, almonds, oatmeal--exercise daily, have been eating flaxseed for years, take a good multi-vitamin and fish oil, drink lots of green tea (no soft drinks, ever), miminal amounts of sugar and white flour, and had OK numbers till I had to stop taking red yeast rice at the beginning of the year because of elevated liver enzymes.  At the time I had been getting physical therapy for a muscle ache which improved spontaneously when I quit using the red yeast rice.  I tried the statins years ago, before I found red yeast rice, and couldn't take any of them.  After I quit taking the red yeast rice, I tried phytosterols and sytrinol, and both caused the same muscle pain as the red yeast rice, and added another weird sympton.  I would wake up with one of the fingers on my right hand bent and be unable to straighten it except by opening it with a finger from my left hand. I tried polycosanol a couple years ago and had problems with it, too.  I tried gugulipid before the red yeast rice but it didn't seem to be effective.  I couldn't take Zetia, either.  I don't know whether the rheumatoid arthritis I was diagnosed with many years ago is a factor or not, but it looks as if the only thing left to try is a bile acid binding resin, unless you have another suggestion!
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